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Japanese Journal of Clinical Oncology 21:372-376 (1991)
© 1991 Foundation for Promotion of Cancer Research

case-report

Severe Herpes Simplex Virus Hepatitis Following Autologous Bone Marrow Transplantation: Successful Treatment with High Dose Intravenous Acyclovir

Masaki Hayashi1, Kunihiko Takeyama1, Jun Takayama2, Mutsuo Ohira2, Kensei Tobinai1,* and Masanori Shimoyama1

1Hematology-Oncology and Medical Oncology Division 1-1, Tsukiji 5-chome, Chuo-ku, Tokyo 104
2Department of Pediatrics, National Cancer Center Hospital 1-1, Tsukiji 5-chome, Chuo-ku, Tokyo 104

*For reprints and all correspondence

Received April 11, 1991; accepted May 21, 1991

A 17-year-old male patient with T-cell type lymphoblastic lymphoma in complete remission underwent high dose chemotherapy (busulfan 16 mg/kg and cyclophosphamide 120 mg/kg) followed by autologous bone marrow transplantation (ABMT). The patient had been taking oral acyclovir (200 mg x 5) daily from seven days prior to the ABMT (day - 7). On day + 24, he complained of epigastralgia and general malaise, and the next day his GOT and GPT rose to 570 U/I and 397 U/I, respectively. Although he had no mucocutaneous lesions, hepatitis caused by a herpes virus was suspected, and high dose intravenous acyclovir (10 mg/kg x 3/day) was immediately started. His GOT, GPT and total bilirubin reached peaks of 2, 870 U/I on day +26, 1, 830 U/I on day +27 and 10.3mg/dl on day +39, respectively, and rapidly improved thereafter. Sero-logical analyses on IgG antibody titers to herpes simplex virus type 1 using an enzyme-linked immunosorbent assay revealed specific increases (454-fold before transplantation to 3, 830-fold on day +46). Antiviral antibody titers to cytomegalovirus, varicella-zoster virus and Epstein-Barr virus showed no significant changes. The serologic markers of hepatitis B virus, hepatitis A virus and hepatitis C virus were all negative. The results indicate the patient's severe icteric hepatitis to have been caused by a reactivation of herpes simplex virus type 1 due to immunosuppression after high dose chemotherapy with ABMT. It is suggested that prompt commencement of high dose intravenous acyclovir is required to treat severe herpes simplex virus hepatitis affecting immunocompromised patients.

Key Words: Autologous bone marrow transplantation • Hepatitis • Herpes simplex virus • High dose chemotherapy


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